Resin Infiltration Versus Fluoride-Based Therapies in the Management of White Spot Lesions, with Relevance to Athletes and Sports Dentistry: A Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.66.74138Keywords
white spot lesions, resin infiltration, fluoride varnish, CPP-ACP, orthodontic treatment, enamel demineralization, athletes, sports dentistryAbstract
Background: White spot lesions (WSLs) are the most common esthetic complication of fixed orthodontic treatment, resulting from subsurface enamel demineralization around brackets. Athletes are a recognized high-risk group, in whom acidic sports drinks and exercise-related hyposalivation promote demineralization, linking WSL care to sports dentistry. Fluoride-based therapies (FBT) remain standard for prevention but poorly mask established lesions, whereas resin infiltration (RI) optically camouflages WSLs by refractive index matching. Aim: To compare the efficacy, esthetic outcomes, durability and safety of RI and FBT in post-orthodontic WSLs and outline evidence-based recommendations. Materials and Methods: A narrative review used PubMed, Scopus and Google Scholar, including trials, reviews, meta-analyses and clinical and in vitro studies (2014–2025). Results: RI provided superior immediate and short-term masking versus fluoride varnish, with significantly greater reductions in colour difference (ΔE) stable up to four years. FBT (5% NaF varnish, CPP-ACP) arrested lesions and promoted remineralization but poorly resolved discoloration. Conclusions: RI is the most predictable option for immediate esthetic management of post-orthodontic WSLs, while FBT remains essential for prevention and biological stabilization; a combined sequential strategy appears most effective, particularly in physically active patients. Long-term randomized trials with standardized outcomes are needed.
References
1. Al-Blaihed D, El Meligy O, Baghlaf K, Aljawi RA, Abudawood S. White spot lesions in fixed orthodontics: a literature review on etiology, prevention, and treatment. Cureus. 2024;16(7):e65679. doi:10.7759/cureus.65679.
2. Lopes PC, Carvalho T, Gomes ATPC, Veiga N, Blanco L, Correia MJ, Mello-Moura ACV. White spot lesions: diagnosis and treatment—a systematic review. BMC Oral Health. 2024;24(1):58. doi:10.1186/s12903-023-03720-6.
3. Lazar L, Vlasa A, Beresescu L, Bud A, Lazar AP, Matei L, Bud E. White spot lesions (WSLs)—post-orthodontic occurrence, management and treatment alternatives: a narrative review. J Clin Med. 2023;12(5):1908. doi:10.3390/jcm12051908.
4. Jha AK, Chandra S, Shankar D, Murmu DC, Noorani MK, Tewari NK. Evaluation of the prevalence of white spot lesions during fixed orthodontic treatment among patients reporting for correction of malocclusion: a prevalence study. Cureus. 2023;15(7):e42134. doi:10.7759/cureus.42134.
5. Weyland MI, Jost-Brinkmann PG, Bartzela T. Management of white spot lesions induced during orthodontic treatment with multibracket appliance: a national-based survey. Clin Oral Investig. 2022;26(7):4871-4883. doi:10.1007/s00784-022-04454-5.
6. Manoharan V, Arun Kumar S, Arumugam SB, Anand V, Krishnamoorthy S, Methippara JJ. Is resin infiltration a microinvasive approach to white lesions of calcified tooth structures? A systemic review. Int J Clin Pediatr Dent. 2019;12(1):53-58. doi:10.5005/jp-journals-10005-1579.
7. Brescia AV, Montesani L, Fusaroli D, Docimo R, Di Gennaro G. Management of enamel defects with resin infiltration techniques: two years follow up retrospective study. Children (Basel). 2022;9(9):1365. doi:10.3390/children9091365.
8. Lamorgese M, Veiga N, Correia MJ, Gomes ATPC, Lopes S, Lopes-Rocha L, Fidalgo-Pereira R, Lopes PC. White spot lesion treatment options: a systematic review of different techniques for masking these lesions. Gels. 2025;11(5):371. doi:10.3390/gels11050371.
9. Soveral M, Machado V, Botelho J, Mendes JJ, Manso C. Effect of resin infiltration on enamel: a systematic review and meta-analysis. J Funct Biomater. 2021;12(3):48. doi:10.3390/jfb12030048.
10. Wierichs RJ, Selzner H, Bourouni S, Kalimeri E, Seremidi K, Meyer-Lückel H, Kloukos D. Masking-efficacy and caries arrestment after resin infiltration or fluoridation of initial caries lesions in adolescents during orthodontic treatment—a randomised controlled trial. J Dent. 2023;138:104713. doi:10.1016/j.jdent.2023.104713.
11. Chan AKY, Tamrakar M, Jiang CM, Tsang YC, Leung KCM, Chu CH. Clinical evidence for professionally applied fluoride therapy to prevent and arrest dental caries in older adults: a systematic review. J Dent. 2022;125:104273. doi:10.1016/j.jdent.2022.104273.
12. Pajor K, Pajchel L, Kolmas J. Hydroxyapatite and fluorapatite in conservative dentistry and oral implantology—a review. Materials (Basel). 2019;12(17):2683. doi:10.3390/ma12172683.
13. da Silva APL, de Oliveira TP, Nogueira RD, Lepri CP, de Oliveira MAHM, Palma-Dibb RG, Geraldo-Martins VR. Evaluation of preventive methods used to interrupt the progression of early caries lesions. J Clin Exp Dent. 2025;17(11):e1376-e1381. doi:10.4317/jced.62588.
14. Puleio F, Fiorillo L, Gorassini F, Iandolo A, Meto A, D’Amico C, Cervino G, Pinizzotto M, Bruno G, Portelli M, Amato A, Lo Giudice R. Systematic review on white spot lesions treatments. Eur J Dent. 2022;16(1):41-48. doi:10.1055/s-0041-1731931.
15. Khoroushi M, Kachuie M. Prevention and treatment of white spot lesions in orthodontic patients. Contemp Clin Dent. 2017;8(1):11-19. doi:10.4103/ccd.ccd_216_17
16. Petker-Jung W, Ruf S, Bock NC. Prophylaxis during multibracket appliance treatment—a survey among general dentists in Germany. BMC Oral Health. 2025;25(1):472. doi:10.1186/s12903-025-05843-4.
17. Ravi Kiran KR, Sabrish S, Mathew S, Shivamurthy PG, Sagarkar R. Effectiveness of amine fluoride mouthwash in preventing white spot lesions during fixed orthodontic therapy—a randomized control trial. Indian J Dent Res. 2023;34(3):261-265. doi:10.4103/ijdr.ijdr_984_21
18. Benson PE, Parkin N, Dyer F, Millett DT, Germain P. Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment. Cochrane Database Syst Rev. 2019;(11):CD003809. doi:10.1002/14651858.CD003809.pub4
19. Grocholewicz K, Mikłasz P, Zawiślak A, Sobolewska E, Janiszewska-Olszowska J. Fluoride varnish, ozone and octenidine reduce the incidence of white spot lesions and caries during orthodontic treatment: randomized controlled trial. Sci Rep. 2022;12(1):13985. doi:10.1038/s41598-022-18107-w
20. Imani MM, Safaei M, Afnaniesfandabad A, Moradpoor H, Sadeghi M, Golshah A, Sharifi R, Mozaffari HR. Efficacy of CPP-ACP and CPP-ACPF for prevention and remineralization of white spot lesions in orthodontic patients: a systematic review of randomized controlled clinical trials. Acta Inform Med. 2019;27(3):199-204. doi:10.5455/aim.2019.27.199-204.
21. Singh S, Singh SP, Goyal A, Utreja AK, Jena AK. Effects of various remineralizing agents on the outcome of post-orthodontic white spot lesions (WSLs): a clinical trial. Prog Orthod. 2016;17(1):25. doi:10.1186/s40510-016-0138-9.
22. Bourouni S, Dritsas K, Kloukos D, Wierichs RJ. Efficacy of resin infiltration to mask post-orthodontic or non-post-orthodontic white spot lesions or fluorosis—a systematic review and meta-analysis. Clin Oral Investig. 2021;25(8):4711-4719. doi:10.1007/s00784-021-03931-7.
23. Kashash Y, Hein S, Göstemeyer G, Aslanalp P, Weyland MI, Bartzela T. Resin infiltration versus fluoride varnish for visual improvement of white spot lesions during multibracket treatment: a randomized-controlled clinical trial. Clin Oral Investig. 2024;28(6):308. doi:10.1007/s00784-024-05695-2.
24. Cosma LL, Şuhani RD, Mesaroş A, Badea ME. Current treatment modalities of orthodontically induced white spot lesions and their outcome—a literature review. Med Pharm Rep. 2019;92(1):25-30. doi:10.15386/cjmed-1090.
25. Alamoudi RA, Yaseen AA, Alharthi AS, Bagher SM. Patient satisfaction with resin infiltration treatment for masking noncavitated white spot lesions on anterior maxillary teeth: two case reports. Case Rep Dent. 2022;2022:9180553. doi:10.1155/2022/9180553.
26. Prada AM, Potra Cicalău GI, Ciavoi G. A review of white spot lesions: development and treatment with resin infiltration. Dent J (Basel). 2024;12(12):375. doi:10.3390/dj12120375.
27. Khan A, Maran S, Jain R, Verma S, Singh JS, Khan M. Effect of resin infiltration system and pit-fissure sealant on white spot lesion: an in vitro study. Bioinformation. 2025;21(1):169. doi:10.6026/973206300211169
28. Taştan E, Taştan H, Gürcan AT. Effect of resin infiltration application on early proximal caries lesions in vitro. J Clin Exp Dent. 2021;13(1):e1-e7. doi:10.4317/jced.57601.
29. Yadav M, Bhattacharya A, Logani A, Srivastava D, Bhatt D, Kumari A. An in vitro evaluation of Icon resin infiltrant penetration into demineralized enamel lesions using an indirect staining technique with confocal laser scanning microscope analysis in dual fluorescence mode. J Conserv Dent Endod. 2024;27(3):278-283. doi:10.4103/jcd.jcd_478_23.
30. Mohamed YS, Shamel M, El Banna S. Laser-assisted Icon and Clinpro for restoring white spot lesions: an in vitro comparative study. Odontology. Published online 2024. doi:10.1007/s10266-024-01026-9
31. Yasser R, Metz M, Attin T, Becker K, Wierichs RJ. The penetration depth of resin infiltration into enamel: a systematic review. Materials (Basel). 2023;16(14):4984. doi:10.3390/ma16144984.
32. Hussain U, Kunwar SS, Khan UW, Kamran MA, Thakfan AS, Alshahrani OA, Rehman A, Niazi FH, Shah AM, Alam S, Campobasso A. Efficacy of various interventions for the management of white spot lesions associated with fixed orthodontic treatment: a systematic review and network meta-analysis of randomized controlled trials. BMC Oral Health. 2026;26:358. doi:10.1186/s12903-026-07755-3
33. Xie Z, Yu L, Li S, Li J, Liu Y. Comparison of therapies of white spot lesions: a systematic review and network meta-analysis. BMC Oral Health. 2023;23(1):346. doi:10.1186/s12903-023-03076-x.
34. Elrashid A, Almarjan M, Alwasem H, Abo Sharakh M, Al Amer H. Comparing the aesthetic outcomes of orthodontically induced white spot lesion using Icon resin infiltration, fluoride varnish and micro-abrasion: a pilot study. J Pharm Bioallied Sci. Published online 2024. doi:10.4103/jpbs.jpbs_1985_24
35. Giray FE, Durhan MA, Haznedaroglu E, Durmus B, Kalyoncu IO, Tanboga I. Resin infiltration technique and fluoride varnish on white spot lesions in children: preliminary findings of a randomized clinical trial. Niger J Clin Pract. 2018;21(12):1564-1569. doi:10.4103/njcp.njcp_209_18.
36. Baptista-Sánchez H, Antonio-Zancajo L, Albaladejo-Martínez A, Colino Gallardo P, Garcovich D, Alvarado-Lorenzo M, Alvarado-Lorenzo A. Changes in the color and brightness of white spots associated with orthodontic treatment 6 months after the application of infiltrative resins: systematic review and meta-analysis. Int J Environ Res Public Health. 2022;19(15):9277. doi:10.3390/ijerph19159277.
37. Alkilzy M, Tarabaih A, Santamaria RM, Splieth CH. Self-assembling peptide P11-4 and fluoride for regenerating enamel. J Dent Res. 2018;97(2):148-154. doi:10.1177/0022034517730531.
38. Puleio F, Di Spirito F, Lo Giudice G, Pantaleo G, Rizzo D, Lo Giudice R. Long-term chromatic durability of white spot lesions through employment of infiltration resin treatment. Medicina (Kaunas). 2023;59(4):749. doi:10.3390/medicina59040749.
39. Saccucci M, Corridore D, Di Carlo G, Bonucci E, Cicciù M, Vozza I. Assessment of enamel color stability of resins infiltration treatment in human teeth: a systematic review. Int J Environ Res Public Health. 2022;19(18):11269. doi:10.3390/ijerph191811269.
40. Abang Ibrahim DF, Venkiteswaran A, Hasmun NN. Esthetic effects and color stability of resin infiltration on demineralized enamel lesions: a systematic review. J Int Soc Prev Community Dent. 2023;13(4):273-286. doi:10.4103/jispcd.JISPCD_29_23.
41. Cazzolla AP, De Franco AR, Lacaita M, Lacarbonara V. Efficacy of 4-year treatment of Icon infiltration resin on post-orthodontic white spot lesions. BMJ Case Rep. 2018;2018:bcr2018225639. doi:10.1136/bcr-2018-225639.
42. Wierichs RJ, Abou-Ayash S, Kobbe C, Esteves-Oliveira M, Wolf M, Knaup I, Meyer-Lueckel H. Evaluation of the masking efficacy of caries infiltration in post-orthodontic initial caries lesions: 1-year follow-up. Clin Oral Investig. 2023;27(4):1895-1904. doi:10.1007/s00784-022-04843-w.
43. Sabti MY, Alfarhan IY, Akbar AA, Qudeimat MA. Evaluating color stability and enamel surface roughness following resin infiltration treatment. Clin Exp Dent Res. 2024;10(1):e2834. doi:10.1002/cre2.834.
44. Alqahtani S, Abusaq A, Alghamdi M, Shokair N, Albounni R. Colour stability of resin infiltrated white spot lesion after exposure to stain-causing drinks. Saudi J Biol Sci. 2022;29(2):1079-1084. doi:10.1016/j.sjbs.2021.09.063.
45. Almulhim K, Khan AS, Alabdulghani H, Albasarah S, Al-Dulaijan Y, Al-Qarni FD. Effect of ageing process and brushing on color stability and surface roughness of treated white spot lesions: an in vitro analysis. Clin Cosmet Investig Dent. 2021;13:413-419. doi:10.2147/CCIDE.S334633.
46. Saeed HYA, Sedky RAF, Diab ENA. Effect of resin infiltration and remineralization on color restorability and stability of artificial demineralized enamel lesions. BMC Oral Health. 2026;26:639. doi:10.1186/s12903-026-08122-y
47. Chabuk MM, Al-Shamma AM. Surface roughness and microhardness of enamel white spot lesions treated with different treatment methods. Heliyon. 2023;9(7):e18283. doi:10.1016/j.heliyon.2023.e18283.
48. Alsafi NM, Taher NM, Alwohaibi RN. Microhardness and surface roughness of resin infiltrated bleached enamel surface using atomic force microscopy: an in vitro study. Saudi Dent J. 2023;35(6):692-698. doi:10.1016/j.sdentj.2023.07.001.
49. Chindane AA, Patil AT, Sandhyarani B. Effect of CPP-ACPF, resin infiltration, and colloidal silica infiltration on surface microhardness of artificial white spot lesions in primary teeth: an in vitro study. Dent Res J (Isfahan). 2022;19:52. doi:10.4103/drj.drj_107_21.
50. Gálvez-Bravo F, Edwards-Toro F, Contador-Cotroneo R, Opazo-García C, Contreras-Pulache H, Goicochea-Palomino EA, Cruz-Gonzales G, Moya-Salazar J. Erosive potential of sports, energy drinks, and isotonic solutions on athletes’ teeth: a systematic review. Nutrients. 2025;17(3):403. doi:10.3390/nu17030403.
51. Mielle B, Júdice A, Proença L, Machado V, Vieira AM, Mendes JJ, Manso C, Rozan C, Botelho J. Dental caries, tooth erosion and nutritional habits in a cohort of athletes: a cross-sectional study. Nutrients. 2025;17(3):543. doi:10.3390/nu17030543.
52. Memon MA, Khan MA, Ahmad M, Tariq I, Younus K, Aleem B, Lee KY. Sports drinks and dental erosion: unveiling the evidence from a systematic review. Curr Oral Health Rep. 2025;12(1):11. doi:10.1007/s40496-025-00401-x.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Marta Kwiatkowska, Zuzanna Małek, Katarzyna Waśkowska, Weronika Kubiak, Aleksandra Wyciślok, Julia Kalsztein, Olgierd Czapiński, Kacper Wiertelak-Makała
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 5
Number of citations: 0
